Concerns at ‘one legged’ public health restructure

Public health doctors and directors have expressed serious concerns over the government’s restructuring plans in a survey shared exclusively by HSJ.

Only 7 per cent said they thought the white paper would lead to an improvement in the population’s health, in the survey of 1,160 members by the UK Faculty of Public Health. Nearly 40 per cent of those surveyed thought the white paper would not lead to any improvement.

The survey was completed by regional directors of public health, directors of public health, consultants in public health, consultants in communicable disease control and academics. It found just over a third thought the proposed structures would offer worse or much worse value for money. Half the number thought it would improve efficiency.

The white paper announced that public health budgets would be ringfenced and public health devolved from primary care trusts to local authorities which most respondents supported. The emphasis on outcomes and National Institute for Health and Clinical Excellence standards was also welcomed.

However, there were worries. More than half of respondents said they did not think the restructuring sufficiently covered the three key domains of health protection, health promotion and public health in healthcare services.

Faculty president Lindsey Davies said putting public health with local authorities meant there was a danger public health specialists could find themselves only dealing with health promotion. She said this would be “a real waste of talent”.

“It makes the whole thing one legged,” Professor Davies added. She said that public health workers have been left with uncertainty in the period between the Liberating the NHS white paper and a public health white paper, due before the end of the year.

More than half of the sample said they could not tell what the impact of the white paper would be at this stage and concerns were raised over a lack of detail and a perceived lack of consultation with public health specialists.

The response to GP commissioning was mixed, with 26 per cent in support and 28 per cent against, but those surveyed overwhelmingly agreed it was vital there should be public health input into GP commissioning.

Twenty-nine people, or 3 per cent, said they would retire from or move out of public health following the restructure and a further 14 per cent said they would consider leaving the field.